By Bill Frack, Co-founder & Chief Product Officer
Hidden inefficiencies in your health plan could be quietly costing you millions.
Healthcare payment systems are notoriously complex. TPAs manage payments to thousands of providers, each governed by distinct contract terms, based on your unique plan design, and often rely on outdated systems to do so. It’s no surprise that payment errors, both large and small, are rampant.
These errors represent unnecessary financial leakage from your health plan, and they happen more often than most employers realize.
Example Administrative Failures
Here are some real-world examples of costly mistakes Wellnecity has uncovered and corrected:
$100,000 Rebate Underpayment
A client’s PBM rebate tracking model failed to account for specific drug rebate rules, leading to delays and missed revenue opportunities.
$800,000 Access Fee Overcharge
Blue Cross network administrative fees were incorrectly applied to more than 40% of claims.
$100,000 Miscoded Administrative Fees
A TPA failed to properly adjust administrative fees for value-added services, leading to overcharges.
$210,000 Stop-Loss Carrier Error
Despite promises of superior integration, a BUCA carrier experienced mismatches in Social Security numbers, resulting in underpayment of stop-loss claims.
$180,000 Average Sales Price (ASP) Errors
When a PBM reconciliation used incorrect Average Sales Price values, Wellnecity identified the error and worked with the PBM to secure a $180,000 credit.
These are just a few examples of the types of errors we uncover regularly.
You Don’t Have to Settle for Mistakes.
These administrative errors don’t benefit employers—but you don’t have to accept them. Modern technology already makes it possible to quickly identify and correct costly inefficiencies, saving time and resources.
Is your health plan leaking company resources?
Isn’t it your fiduciary duty to ensure it isn’t?
Questions: Contact me directly at b.frack@wellnecity.com.